In the Journals

Patients with prior CABG more likely to have reperfusion delays when receiving PCI for STEMI

Among patients undergoing PCI for STEMI, those with prior CABG were more likely to have reperfusion delays than those who did not undergo CABG, according to a new study.

However, patients with a history of prior PCI were no more likely to have reperfusion delays than those without any prior revascularization, and after adjustment, in-hospital outcomes were similar for all three groups, researchers found.

Luis Gruberg, MD, and colleagues analyzed 15,628 patients from two National Cardiovascular Data Registry databases with STEMI who underwent primary PCI between June 2009 and September 2011, to determine whether there were any differences between those with prior CABG, those with prior PCI and those with no prior revascularization in door-to-balloon times and in-hospital MACCE.

Compared with the other two groups, those with prior CABG were older and more likely to have multiple comorbidities (P < .0001).

Slower time to reperfusion

Compared with patients with no prior revascularization, those with prior CABG were less likely to have a guideline-recommended door-to-balloon time of 90 minutes or less (76.4% vs. 88%), but patients with prior PCI were not (88.5% vs. 88%).

Procedural success rates were 88.3% in patients with prior CABG, compared with 93.4% for those with prior PCI and 94.4% of those with no prior revascularization (P < .0001).

In an unadjusted model, patients with prior CABG had greater risk for in-hospital mortality (OR = 1.73; 95% CI, 1.15-2.6) and in-hospital MACCE (OR = 1.68; 95% CI, 1.21-2.31) compared with patients with no prior revascularization, according to the researchers.

However, after multivariable adjustment, the differences were no longer significant (OR for in-hospital mortality = 1.03; 95% CI, 0.64-1.68; OR for in-hospital MACCE = 1.07; 95% CI, 0.77-1.49), they found.

“Nonetheless, every effort should be made to improve timeliness in patients with a history of previous [CABG],” Gruberg, professor of medicine at Stony Brook University, Stony Brook, New York, said in a press release.

In unadjusted and adjusted models, patients with prior PCI had no differences in risk for in-hospital mortality (adjusted OR = 1.12; 95% CI, 0.76-1.63) and in-hospital MACCE (adjusted OR = 0.9; 95% CI, 0.68-1.18) compared with those with no prior revascularization, Gruberg and colleagues wrote.

Call to action

In a related editorial, John S. Douglas Jr., MD, from Andreas Gruentzig Cardiovascular Center, division of cardiology, department of medicine, Emory University School of Medicine, Atlanta, wrote that important take-home messages from the study include that those with prior CABG had reperfusion delays compared with those who had never had CABG, and that they had a higher unadjusted rate of in-hospital MACCE.

“The observations of Gruberg et al. should be interpreted as a `call to action,’ with the goal of earliest possible reperfusion in all patients who have STEMI, including those who have had a previous CABG,” he wrote. – by Erik Swain

Disclosure: Gruberg reports receiving speaking honoraria from AstraZeneca and Janssen Pharmaceuticals. See the full study for a list of the other researchers’ relevant financial disclosures. Douglas reports no relevant financial disclosures.

Among patients undergoing PCI for STEMI, those with prior CABG were more likely to have reperfusion delays than those who did not undergo CABG, according to a new study.

However, patients with a history of prior PCI were no more likely to have reperfusion delays than those without any prior revascularization, and after adjustment, in-hospital outcomes were similar for all three groups, researchers found.

Luis Gruberg, MD, and colleagues analyzed 15,628 patients from two National Cardiovascular Data Registry databases with STEMI who underwent primary PCI between June 2009 and September 2011, to determine whether there were any differences between those with prior CABG, those with prior PCI and those with no prior revascularization in door-to-balloon times and in-hospital MACCE.

Compared with the other two groups, those with prior CABG were older and more likely to have multiple comorbidities (P < .0001).

Slower time to reperfusion

Compared with patients with no prior revascularization, those with prior CABG were less likely to have a guideline-recommended door-to-balloon time of 90 minutes or less (76.4% vs. 88%), but patients with prior PCI were not (88.5% vs. 88%).

Procedural success rates were 88.3% in patients with prior CABG, compared with 93.4% for those with prior PCI and 94.4% of those with no prior revascularization (P < .0001).

In an unadjusted model, patients with prior CABG had greater risk for in-hospital mortality (OR = 1.73; 95% CI, 1.15-2.6) and in-hospital MACCE (OR = 1.68; 95% CI, 1.21-2.31) compared with patients with no prior revascularization, according to the researchers.

However, after multivariable adjustment, the differences were no longer significant (OR for in-hospital mortality = 1.03; 95% CI, 0.64-1.68; OR for in-hospital MACCE = 1.07; 95% CI, 0.77-1.49), they found.

“Nonetheless, every effort should be made to improve timeliness in patients with a history of previous [CABG],” Gruberg, professor of medicine at Stony Brook University, Stony Brook, New York, said in a press release.

In unadjusted and adjusted models, patients with prior PCI had no differences in risk for in-hospital mortality (adjusted OR = 1.12; 95% CI, 0.76-1.63) and in-hospital MACCE (adjusted OR = 0.9; 95% CI, 0.68-1.18) compared with those with no prior revascularization, Gruberg and colleagues wrote.

Call to action

In a related editorial, John S. Douglas Jr., MD, from Andreas Gruentzig Cardiovascular Center, division of cardiology, department of medicine, Emory University School of Medicine, Atlanta, wrote that important take-home messages from the study include that those with prior CABG had reperfusion delays compared with those who had never had CABG, and that they had a higher unadjusted rate of in-hospital MACCE.

“The observations of Gruberg et al. should be interpreted as a `call to action,’ with the goal of earliest possible reperfusion in all patients who have STEMI, including those who have had a previous CABG,” he wrote. – by Erik Swain

Disclosure: Gruberg reports receiving speaking honoraria from AstraZeneca and Janssen Pharmaceuticals. See the full study for a list of the other researchers’ relevant financial disclosures. Douglas reports no relevant financial disclosures.